Background
Masked phenomenon, Masked Hypertension (MHT) and Masked Uncontrolled Hypertension
(MUCH) is a well-defined clinical entity. However, many aspects of MHT/MUCH remain
unclear.
Methods
We systematically reviewed the published literature on MHT/MUCH from 1 January 2000
to 31 June 2018 with a particular focus on epidemiology, clinical significance, evaluation
and management. Meta-analyses were performed with respect to prevalence, clinical
significance and diagnostic agreement between home blood pressure (HBP) and ambulatory
BP (ABP) measurements.
Results
The overall weighted-mean prevalence of masked phenomenon was 11% [9,14]; MHT 10%
[9,11]; and MUCH 13% [8,17]. The weighted-mean prevalence when expressed as a proportion
of patients with normal office BP was 32% [25,40]; MHT 28% [15,41]; and MUCH 43% [29,57].
The prevalence of masked phenomenon determined by ABP (11% [8,14]) and HBP (13% [9,16]),
was similar. However, ABP appeared to have a greater sensitivity, i.e. proportion
of patients diagnosed as having MHT/MUCH was greater with ABP than with HBP (22% v
16%, p < 0.05), when both methodologies were applied to the same cohort of patients. The prevalence
of MHT was influenced by ethnicities and comorbidities, and in case of MUCH by anti-hypertensive
treatment. MHT/MUCH was associated with increased risk of fatal and non-fatal cardiac/cerebrovascular
events (relative risk [RR] 2.09 [1.80, 2.44]), and the risk was comparable to sustained
hypertension (SHT) (RR 2.26 [1.84, 2.78]). The increased risk occurred regardless
of the method of out of office BP assessment; the relative risks for ABP and HBP were
2.38 [1.90, 2.98] and 1.90 [1.57, 2.29] respectively. The diagnostic agreement between
ABP and HBP was only modest, kappa = 0.46 [0.40, 0.52], even though the percentage
agreement was 83%. The evidence for the management of MHT was scant.
Conclusions
MHT/MUCH is a common BP phenotype with a risk profile similar to that of SHT. Therefore,
high risk patients should undergo out of office BP assessment, probably both by HBP
and ABP, to confirm diagnosis and be considered for treatment.
Keywords
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Article info
Publication history
Published online: August 16, 2019
Accepted:
August 4,
2019
Received in revised form:
June 15,
2019
Received:
January 3,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
